376618682-4-26-2022-51-CC-ASUD-CDUNEF-20220426102352

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376618682
Report Date: 04/26/2022
Date Signed: 04/26/2022 10:24:15 AM

Document Has Been Signed on 04/26/2022 10:24 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME:	CHAVEZ, IRENE FAMILY CHILD CARE		FACILITY NUMBER:	376618682
ADMINISTRATOR:	IRENE CHAVEZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(619) 507-7446
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92115
CAPACITY:	14	CENSUS: 0	DATE:	04/26/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:06 AM
MET WITH:	Irene Chavez		TIME COMPLETED:	10:40 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 4/26/22 at 9:06 am Licensing Program Analyst (LPA) Annette Sutherland arrived at the facility to conduct an unannounced annual inspection. LPA was granted entry by Licensee, Irene Chavez. Also present was her adult son Danny Ngo Chavez. Licensee was provided the Inspection Checklist (LIC 126) upon entry to the facility. The one story home was toured and inspected to ensure an environment safe for the care and supervision of children. There are no care children present. Licensee has provided adequate space for the children to eat, sleep and play within the home. Areas used for childcare include Dining room, Living room, Bathroom #1 and Front yard. Off limits areas include all Bedrooms (3), Bathroom #2, Kitchen, and garage. These areas are inaccessible through use of safety gates and door knob covers. There is a working phone at the facility. The fire extinguisher, carbon monoxide detector, and smoke detector meet requirements and are operational. All hazardous items were latched/locked and secured out of reach of children, this includes detergents, cleaning compounds, medications and other items which could pose a danger to children. Inaccessibility of hazards must be constantly reassessed depending on the children in care. Verification of control of property is on file. Licensee rents the home. Facility Sketch, Emergency Disaster Plan & Notification of Parent’s Rights poster are posted. Pediatric CPR and First Aid Card expire on October 2022 for Irene Chavez. Licensee meets immunization requirements. Mandated Reporter has not been taken since 2018. Licensee has conducted disaster drills, last drill was conducted on 4/25/22. Children’s records were not reviewed. Licensee provided copy of completed roster. Continued on LIC 809c

SUPERVISOR'S NAME: Monica Cuddy	TELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Annette Sutherland	TELEPHONE: (619) 629-8751
LICENSING EVALUATOR SIGNATURE:	DATE: 04/26/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: CHAVEZ, IRENE FAMILY CHILD CARE	FACILITY NUMBER: 376618682
	VISIT DATE: 04/26/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

There are no bodies of water. Licensee understands all bodies of water including ponds, above ground pools & spas, in-ground pools & spas, and some fountains must be properly covered or fenced per Title 22 regulations. The Department must be notified before and after installation of the above types of bodies of water. In addition, all wading pools or similar product must be emptied immediately after use and stored in an upright position.

No guns or weapons present as stated by the Licensee. Licensee understands all guns, weapons and ammunition must be key locked separately and made inaccessible per Title 22 regulations. The home is clean and orderly, with heating and ventilation for safety and comfort. Safe and age appropriate toys and equipment are present for both indoor and outdoor activities. Licensee will be using backyard for outdoor activities.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

The inspection consisted of reviews of the following domains: Physical Plant, Care and Supervision, Facility Administration, Records, Staffing Ratio and Capacity, and Personal Rights.

Access to forms & Regulations for Family Child Care are online at www.ccld.ca.gov. Please note it is you Responsibility to know the regulations for anyone providing care. The Duty Officer is available to answer questions Monday – Friday at (619) 767-2248 for any Unusual Incident Reporting.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.
Continues LIC 809C

SUPERVISOR'S NAME: Monica Cuddy	TELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Annette Sutherland	TELEPHONE: (619) 629-8751
LICENSING EVALUATOR SIGNATURE:	DATE: 04/26/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2022

LIC809 (FAS) - (06/04)

Page: 4 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: CHAVEZ, IRENE FAMILY CHILD CARE	FACILITY NUMBER: 376618682
	VISIT DATE: 04/26/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Provider is hereby reminded of the following: Report suspected child abuse and neglect, maintain children’s records according to regulation, post all required forms, ensure that all adults living or working in the home have criminal background clearances to avoid civil penalties associated with this requirement; corporal punishment, smoking, exersaucers, bouncy seats, walkers, and jumpers are not allowed in day care. All equipment that is used should be used only as intended by the manufacturer. LPAs and Licensee discussed California Megan's Law and LPAs provided: www.meganslaw.ca.gov.

LPA reviewed Covid-19 guidelines with Licensee and provided Covid-19 resources. Please subscribe to childcareadvocatesprogram@dss.ca.gov to receive Department updates. They will be sent directly to your e-mail account once you have set up an account. This website can also be accessed through www.ccld.ca.gov.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Deficiencies are cited. See LIC 809 D .

Exit interview conducted and report was reviewed with the licensee, Irene Chavez. A notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Monica Cuddy	TELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Annette Sutherland	TELEPHONE: (619) 629-8751
LICENSING EVALUATOR SIGNATURE:	DATE: 04/26/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2022

LIC809 (FAS) - (06/04)

Page: 3 of 4

Document Has Been Signed on 04/26/2022 10:24 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: CHAVEZ, IRENE FAMILY CHILD CARE	FACILITY NUMBER: 376618682
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/26/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and record review the licensee did not comply with the section cited above as mandated reporter training has expired. This poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/26/2022
	Plan of Correction
1 2 3 4	Licensee stated she will complete new training within a month.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Monica Cuddy	TELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Annette Sutherland	TELEPHONE: (619) 629-8751
LICENSING EVALUATOR SIGNATURE:	DATE: 04/26/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2022

LIC809 (FAS) - (06/04)

Page: 2 of 4